Background: Shared medical appointments (SMA) via home telemedicine may improve clinic attendance and adherence to care recommendations in adolescent and young adult patients (AYA) with type 1 diabetes (T1D). Participation in home telemedicine requires basic health literacy, reliable access to high-speed Internet on a compatible device, and a private location for attending appointments. AYA from households with lower socioeconomic status (SES) may encounter barriers to participation in home telemedicine due to limited resources. Objective: Evaluate the feasibility of conducting SMA via home telemedicine for low SES AYA with T1D. Methods: We conducted baseline patient and family assessments as part of a prospective study on the use of SMA and telemedicine for AYA with T1D who attend a pediatric outpatient endocrinology clinic. We calculated SES for each family using a modified version of the Hollingshead index, and dichotomized patients into low and high SES groups. Results: AYA reported nearly equal interest in attending SMA (Low: 76%; High: 66%), and in completing appointments online (Low: 41%; High: 45%), regardless of SES. Patients reported having access to high-speed Internet (100%), favored home appointments (Low: 35%; High: 42%), and reported having private space (Low: 83%; High: 88%). Low SES patients were younger than high SES patients (15 vs. 17 years, p = 0.01), and reported shorter disease duration (6 vs. 9 years, p < 0.01). Low SES patients reported needing help reading medical information at least sometimes more frequently (76%) than high SES patients (56%, p = 0.05). However, this effect was attenuated in multiple regression analysis, where variations in patients’ health literacy were associated with age (p < 0.05) instead of SES. Conclusions: Low SES AYA with T1D are equally equipped and interested in utilizing shared telemedicine as high SES patients. Home telemedicine may be a feasible format for diabetes care and psychosocial support for all patients, regardless of SES. Disclosure J.J. Flores Garcia: None. M.W. Reid: None. J. Raymond: None.

Background: AYA with T1D encounter many challenges in managing their diabetes, such as uncontrolled glycemic levels, higher probability of complications, and poor clinic attendance. AYA minorities often encounter health care disparities that could be addressed with culturally competent care, which considers the patient’s diverse background and sociocultural factors like communication, language, and beliefs that may influence health behaviors. Objective: To assess patient-reported provider cultural competence and health care utilization among diverse AYA population with T1D. Methods: Patients were recruited during routine diabetes outpatient care visits and asked to complete questionnaires on sociodemographic variables, health care utilization, and clinical experiences and cultural competence as assessed by the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Results: One-hundred forty three AYA (58.7% Male; 45.5% Latinx, 22.4% non-Latinx white) participated, with an average HbA1c of 9.8% in Latinx and 8.6% in non-Latinx whites. Participants who reported some negative experience with provider cultural competence were marginally lower health care utilizers. Specifically, these AYA went to the ER for diabetes-related problems less frequently (p=0.07), had fewer urgent care visits (p=0.08), went to urgent care for hypoglycemia issues less frequently (p=0.08), and attended fewer diabetes care visits (p=0.07). They also went to urgent care for reasons unrelated to diabetes less frequently (p=0.11) and spent fewer days in the hospital when admitted (p=0.13), but these results were not significant. Conclusions: AYA who experience culturally discordant care may utilize health care less frequently. It is unclear if AYA receiving discordant care need less healthcare support, or if their experiences lead to avoidance of needed care. Our results are hypothesis-generating and further investigation is needed. Disclosure J.J. Flores Garcia: None. J. Raymond: Other Relationship; Self; Insulet Corporation. S. Agarwal: None. A. Torres Sanchez: None. M.W. Reid: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Introduction: CTC is a 15-month intervention study evaluating a patient-centered, home telehealth care model for young adults (YA) ages 16-25 with T1D. The patient-centered CoYoT1 Care arm includes a shared decision-making tool completed by providers (n=3) and patients (n=47) prior to each visit. The present analysis examines how patients and providers collaborated to shape initial visit agendas. Methods: Six potential topics were each rated on a 1-5 scale, where higher values indicate greater importance. Patient and provider ratings within each topic were compared using paired t-tests. Next, ratings were compared between visits where a topic was discussed or not discussed using independent t-tests; patient and provider data were evaluated separately. Results: Blood sugar ranges and supply/medication issues were discussed most frequently. Providers assigned higher overall importance to emotional well-being than their patients (p=0.005), but this topic was only discussed when patients assigned higher importance (p=0.001). Also, despite higher provider ratings, blood sugar ranges were only discussed when patients assigned higher importance (p=0.003). Discussion: Consistent with the CoYoT1 Care model, patients and providers collaborated to shape visit agendas, slightly favoring the patient perspective. Topics discussed were those assigned higher importance by patients and providers. Disclosure J.J. Flores Garcia: None. E. Pyatak: None. M.W. Reid: None. J.L. Fogel: None. J. Diaz: None. J. Raymond: None.

Background: Current type 1 diabetes (T1D) care models do not effectively engage racially and ethnically diverse Adolescents and Young Adults (AYA) indicating a need for new approaches. Objective: To assess clinical and demographic predictors of care engagement among diverse AYA with T1D. Methods: In an ongoing 15-month randomized controlled 2x2 trial with pragmatic care assignment, 53 AYA ages 16-25 received either quarterly usual T1D care (in-person or via telehealth (TH)), or CoYoT1 Care, which includes bimonthly T1D group sessions via TH and quarterly patient-centered care provider visits (in-person or via TH). Participant engagement was measured by the proportion of clinic visits attended out of all offered to date, per participant, including all currently enrolled. Predictors of engagement included: pre-trial clinic attendance, care group assignment (CoYoT1 or usual care), demographic, and clinical variables. All were entered into a multiple linear regression model, then reduced via stepwise regression. Results: Participation in CoYoT1 Care was associated with a 12% greater attendance rate (p=0.006) relative to usual care. Participants who retained their pre-trial care providers during the study attended clinic visits 7% more frequently than those randomized to a new provider (p=0.06). Participants’ who identified as African American (p=0.001) or Multi-racial (p=0.002) attended clinic visits at least 16% more frequently than participants from other groups; Latinx ethnicity was not associated with more or less frequent attendance. Females attended clinic visits 10% less frequently than non-females (p=0.006). Baseline A1c was also negatively associated with attendance rate, with each percentage increase in A1c associated with a 2% reduction in attendance rate (p=0.01). Conclusion: CoYoT1 Care successfully engaged patients from diverse backgrounds. The model warrants further investigation to identify which intervention components most promote engagement. Disclosure J. J. Flores garcia: None. J. Raymond: None. M. W. Reid: None. E. Pyatak: None. D. Fox: None. J. L. Fogel: None. E. Salcedo-rodriguez: None. D. I. Bisno: None. D. Miller: None. A. Mittal: None. Funding The Donaghue Foundation

Type 1 diabetes (T1D) affects many youth in the United States and the incidence is rising. Diabetes technology such as insulin pumps and continuous glucose monitors (CGM) have been associated with improved glycemic control and improved quality of life. However, as of 2015 only 60% of children used a pump and only 6% used CGM. The use of diabetes devices is even lower in minorities. Potential barriers to device uptake in the T1D population have been described, but studies were mostly conducted in adults who were predominantly white, of higher socioeconomic status, and privately insured. Youth with T1D (n=143) followed at Children’s Hospital Los Angeles were surveyed to investigate barriers to diabetes technology and explore potential differences between Latinx and non-Latinx populations. Latinx patients reported higher percentage of never having used CGM (64.6% vs. 41.3%, p=0.005) or pump (50.8% vs. 28.6%, p=0.002), and were found to have higher HbA1c levels (9.3% vs. 8.1%, p=0.0002). Latinx patients had less positive attitudes toward general and diabetes technology as seen in Table 1. Less positive attitudes toward technology in general may contribute to the lack of exposure to diabetes devices in the Latinx community. However, physician-perceived barriers might also contribute to the differences. Further investigation into patient and physician-perceived barriers will assist in improving patient adoption of diabetes technology. Disclosure D. Tsai: None. M.W. Reid: None. J.J. Flores Garcia: None. J. Raymond: Other Relationship; Self; Insulet Corporation. Funding The Leona M. and Harry B. Helmsley Charitable Trust